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					Background
Cushing syndrome is
caused by prolonged
exposure to elevated
levels of either
endogenous
glucocorticoids or
exogenous
glucocorticoids
          Cushing Syndrome…

• Individuals often complain of proximal muscle
  weakness, easy bruising, weight gain,
  hirsutism, and, in children, growth
  retardation. Hypertension, osteopenia,
  diabetes mellitus, and impaired immune
  function may occur.
            Cushing Syndrome…
  Pathophysiology

Excess levels of either exogenously administrated
  glucocorticoids or endogenous overproduction of
  cortisol causes Cushing syndrome. Endogenous
  glucocorticoid overproduction or hypercortisolism that
  is independent of adrenocorticotropic hormone (ACTH)
  is usually due to a primary adrenocortical neoplasm
  (usually an adenoma but rarely a carcinoma). Bilateral
  micronodular hyperplasia and macronodular
  hyperplasia are rare causes of Cushing syndrome.
           Cushing Syndrome…
• ACTH-secreting neoplasms cause ACTH-
  dependent Cushing syndrome. They usually are
  due to an anterior pituitary tumor, that is, classic
  Cushing disease (80%).
• Non-pituitary ectopic sources of ACTH, such as an
  small-cell lung carcinoma, or carcinoid tumor,
• Ectopic corticotropin-releasing hormone (CRH)
  secretion leading to increased ACTH secretion
  comprise a very rare group of cases of Cushing
  syndrome
           Cushing Syndrome…
• Most cases of Cushing syndrome are due to
  exogenous glucocorticoids.

The annual incidence of endogenous Cushing
  syndrome has been estimated at 13 cases per
  million individuals. Of these cases, approximately
  70% are due to Cushing disease, that is, a
  pituitary ACTH-producing tumor; 15% to ectopic
  ACTH; and 15% to a primary adrenal tumor.
          Cushing Syndrome…
• Two catastrophic medical crises that occur in
  glucocorticoid excess states are perforated
  viscera and opportunistic fungal infections
• Exposure to excess glucocorticoids results in
  multiple medical problems, including
  hypertension, obesity, osteoporosis, fractures,
  impaired immune function, impaired wound
  healing, glucose intolerance, and psychosis.
           Cushing Syndrome…
• Exogenous steroids suppress the HPA axis, with
  full recovery taking as long as a year after
  cessation of glucocorticoid administration. Thus,
  patients who are on or who have taken steroids
  are at risk for developing an adrenal crisis if
  steroids are stopped or not increased during an
  acute illness.

For that … If cortisone medication to discontinue

           then…      tapering down !!!
               Cushing Syndrome…
• Similarly, lack of cortisol leading to an adrenal crisis may occur in
  patients with endogenous Cushing syndrome who
  have undergone resection of an ACTH-producing or cortisol-
  producing tumor or who are taking adrenal steroid inhibitors.

History…

•Patients with Cushing syndrome may complain of weight gain,
especially in the face, supraclavicular region, upper back, and torso.

•Frequently, patients notice changes in their skin, including purple
stretch marks, easy bruising, and other signs of skin thinning.
                          HISTORY…
•Because of progressive proximal muscle weakness, patients
may have difficulty climbing stairs, getting out of a low chair,
and raising their arms.
• Menstrual irregularities, amenorrhea, infertility, and
  decreased libido may occur in women due to
  inhibition of pulsatile secretion of luteinizing
  hormone (LH) and follicle-stimulating hormone
  (FSH), which likely is due to interruption of
  luteinizing hormone-releasing hormone (LHRH)
  pulse generation.

• In men, inhibition of LHRH and FSH/LH function may
  lead to decreased libido and impotence.
                          HISTORY…
• Psychological problems such as depression, cognitive dysfunction,
  and emotional lability may develop

• New-onset or worsening of hypertension and diabetes mellitus,
  difficulty with wound healing, increased infections, osteopenia, and
  osteoporotic fractures may occur.

• Patients with an ACTH-producing pituitary tumor (Cushing disease)
  may develop headaches, polyuria and nocturia, visual problems, or
  galactorrhea

• If sufficient mass effect from the tumor is present on the anterior
  pituitary, hyposomatotropism, hypothyroidism, hyperprolactinemia
  or hypoprolactinemia, and hypogonadism may develop.
Complications:
•   Osteoporosis
•   Increased susceptibility to infections
•   Hirsutism
•   Diabetes mellitus
•   Hypertension
•   Risk for adrenal crisis
•   Panhypopituitarism
•   Diabetes insipidus

				
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posted:4/24/2011
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